[Meta] the prior authorization rule is doing its job and people should stop complaining
Right, the denial question again, but with numbers this time. I have 7 data points over 20 weeks. The pattern is consistent enough that I do not think it is chance, and boring enough that nobody is going to screenshot it, which is usually a good sign. The thing I would flag for anyone new: the effect I am describing…
copay is separate from coverage
Copay was step therapy for the copay then another 20% of the total. Read the actual plan document.
Copay was step therapy for the copay then another 20% of the total.
Adding to this: prior authorization is doing more work than the comment implies.
formulary exclusions are negotiable sometimes
Not to be pedantic but formulary and appeal are being used interchangeably and they are not interchangeable in real life.
resubmission after denial requires new documentation